Paradigm shift

Over the last ten years, there have been some astounding advances in the management of diabetes. We have more powerful medications, better insulins, easier ways to monitor blood glucose, and we might even see the first closed loop system (insulin pump/CGM) as early as this summer. Despite these innovations, markers of diabetes control over the last ten years have actually gotten worse according to a study released by the American Diabetes Association.
I believe people with diabetes will continue to have declining outcomes over time unless we attack the management of diabetes with a multi-pronged strategy on five different fronts:
Stress mitigation
Improving duration and quality of sleep
Diet
Exercise
Medication

In my 15 years with type 1 diabetes, I’ve never had a doctor ask me what I eat, what I do for exercise, how I’m mitigating stress, or how I’m sleeping. Doctors are not schooled in the other four prongs of diabetes management nor do they have the incentives to improve the quality of life for people with diabetes. So here is where the paradigm shift comes in. Either patients need to educate themselves on these other four prongs or we need doctors to help us pull together teams of experts trained to help patients with all five prongs of diabetes management. Whether patients take on the responsibilities themselves or rely on a team of experts is immaterial. Somehow the other four prongs need to be addressed in order to improve diabetes outcomes.
I want to share my strategy for managing diabetes. It has taken 15 years to evolve and I really wish I had some more help. The first thing I addressed after diagnosis with type 1 diabetes was diet. I slowly removed wheat and grains from my diet because it was clear I could not control these foods. I experienced way too many highs and lows after eating rice, pasta, breads, cereals, and oatmeal. These foods might not be especially bad for a young healthy person with a functioning pancreas and good insulin sensitivity, but they were a disaster for me. The removal of grains was pivotal because I learned how powerful food choices can be. I then turned to things like protein, coffee, alcohol, and fruit. Protein is great, but too much at a single meal left me chasing highs two to three hours later. Certain fruits like pineapple, strawberries, figs, and some tropical fruits would spike my sugar pretty wildly so these foods had to be minimized or eaten with a more balanced plate of food that included fats and proteins. I learned that I could eats loads of fresh vegetables, healthy fats, appropriately timed carbohydrates in the form of tubers, plantains, and fruit, and quality sources of animal products and achieve an A1C of 5.1 without lows. But I also had to learn how to adopt a healthy sleep routine and learn how to exercise smartly. I also learned that short periods of meditation and long walks helped me mitigate stress.
I share my strategy because there was no one in my life who could help me with the other four prongs. By finally addressing these other aspects of diabetes managementI able to truly take control of this disease and get back into the drivers seat. Ten years ago, I was thrilled by the idea of an artificial pancreas. But now, for myself at least, I’m not interested because I can do a better job. Innovative technologies definitely have their place, but over reliance on doctors, medications, and fancy toys will never provide true control – until a cure is found, of course. I don’t mean to be overly pessimistic, but I don’t think the incentives for a cure currently exist.There is way too much money to be made through the sale of fancy toys and diabetes supplies.
Until there’s a cure, there is a solution.

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